Questions I have about my first a-fib episode & hospitalization

My first a-fib episode a couple/few years ago woke me out of a sound sleep around 6 in the morning....all I knew was that I felt funny--not normal at all, and something was going on and it was wrong! Off we went to the ER where I was dx with a-fib and given a calcium channel blocker in an IV...that did nothing so they increased the dose, and again, nothing.

Then they switched to a beta blocker, told me I was going to be admitted and would have to spend the night. The beta blocker worked after a while, then it was a matter of seeing if I would stay in NSR, which I did. I did not need a cardioversion although that was an option if necessary.

If it's been suggested that I try and wait until an episode of a-fib resolves itself, why did I need to be hospitalized that first time?
Is it because I didn't have any meds for a-fib at all in my system?

I'm still kinda worried about how long to wait when I feel I'm in a-fib (and really, after one episode of SVT, I cannot tell the difference, with how I'm feeling, between when I'm in a-fib or when I'm in SVT). The last time I went to the ER, had waited a couple of hours at home to see if it would resolve, then went to the ER where they said I was in a-fib and observed me for 4 more hours or so.

Thanks!
Sue

Yup, sort of the same story I had in March, 2018 EXCEPT that I had a lone episode in 2008, 2009, 2010 and 2017 that all went away in a day or two with a med called Bystolic. In 2018 I waited 6 days to go to the ER (mistake, I had sustained 150bpm at rest, should have gone earlier).

I ended up in the hospital for two days due to HEART RATE not AFib (so too speak). Once they med'd my HR to below 100bpm resting, they sent me home. They pushed a "loading dose"? od Diltazem (sp?) and put me on Elequis, Diltazem and Metropolol...all of which did nothing for the adib, just the rvr.

Flash forward to three weeks later, after 23 or 26 days in raging AFib they put me on Flecianide and schedule an ablation. Of course the fleciade pops me into normal rhythm is less than 12 hrs! At first I was mad along the lines of "why didn't they just give me flecianide in the hospital". However, I now think if you need flecianide, you're beyond your bodies capability to convert itself AND stay in normal rythym (could be quite wrong, but that's how I interpreted the doc's). And I also knew this was a different afib...before the hospital, I went to my cardio for a bottle of Bystolic and it did nothing. I could tell this episode was gonna be a long one.

All this being said, good news! I feel for you because at first AFib is one scary ride. I remember driving from my primary care to a cardio on my first episode think "Damn! this is it!". The good news is this...the fear WILL subside with experience. You'll likely become an small time afib expert (by lurking here, doc visits, procedures, etc.) and LEARN that while it sucks, it's both generally treatable and manageable. My big hurdle wasn't fixing AFib, but RECOGNIZING that it wasn't life threatening, and this took a couple episodes. A positive that came out of my AFib is the amount of heart testing I have received showing a strong healthy heart.

My recco's? Find a good EP, stay calm (yoga is your friend) and research this forum a lot, it's an amazing wealth of info. Again, I'm sorry you have joined the afib team, but I've run this path (7 total episodes, one with RVR, 2 ablations, many, many doc visits) and there IS normal sinus rhythm at the end! Oh yeah, with the 26 day ride, March 2018, I was so depressed I asked for and got anti-depressants. Waste of time, should have used that energy on learning and mental attitude.

fyi..I use the term"raging AFib" a lot. This is because when I out of rhythm my hard beats strong and scary, I hear/feel every damned beat like my heart is beating between my ears...hate it!

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SueChef
why did I need to be hospitalized that first time?

You didn't.

The trouble is the ER docs feel compelled to do something and all they have available is cardioversion and rate control meds. Since you weren't on anticoagulants the cardioversion is risky, and managing afib with rate control meds isn't an emergent problem so it's not really what ER docs do. So they punt and admit you to let the cardiology department figure it out.

The bottom line is "lone" afib isn't an emergency unless you're experiencing other symptoms such as fainting, dizziness, chest pain, or super high rates (over 200). See an EP, get appropriate rate control meds and an anticoagulant, and wait out the episodes at home. If the episode lasts longer than you can tolerate, THEN go to the ER. You should ask for and hope they'll cardiovert you, but fully expect them to decline and make you spend many hours there waiting for the same thing you'd be waiting for at home.

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Carey

why did I need to be hospitalized that first time?


You didn't.

The trouble is the ER docs feel compelled to do something and all they have available is cardioversion and rate control meds. Since you weren't on anticoagulants the cardioversion is risky, and managing afib with rate control meds isn't an emergent problem so it's not really what ER docs do. So they punt and admit you to let the cardiology department figure it out.

The bottom line is "lone" afib isn't an emergency unless you're experiencing other symptoms such as fainting, dizziness, chest pain, or super high rates (over 200). See an EP, get appropriate rate control meds and an anticoagulant, and wait out the episodes at home. If the episode lasts longer than you can tolerate, THEN go to the ER. You should ask for and hope they'll cardiovert you, but fully expect them to decline and make you spend many hours there waiting for the same thing you'd be waiting for at home.

EXTREMELY well worded, should be a sticky!!

Sue:

I think you did things right, the first several times in AFIB, it makes sense to go to the ER, as time goes on you learn more and are able to tell the difference AFIB from Tachycardia, you will probably not want to go to an ER, unless their is something specific that you wanted done, like a Cardioversion.

Another option, if its during business hours, is to go in to your Cardiologist office for a "Nurses Visit". Usually you can get an Appointment with a Nurse on short notice, they can do an EKG and evaluate your situation, and consult with your Dr. if necessary.

Thank you, pmcaz, Carey, and The Anti-Fib ! Great input and advice!!!
Sue